Digital health technologies for primary health care in rural Sub-Saharan Africa: a systematic review of benefits and implementation challenges

Abstract

Primary health care (PHC) in rural Sub-Saharan Africa (SSA) faces persistent challenges, including workforce shortages, inadequate infrastructure, and geographic isolation. Digital health technologies offer opportunities to strengthen PHC delivery; however, evidence on their implementation remains fragmented. This systematic review synthesized evidence on digital health technologies for rural PHC in SSA, examining the technologies implemented, their benefits, and implementation challenges. Following PRISMA 2020 guidelines, PubMed, Scopus, and Google Scholar were systematically searched for studies published between 2015 and 2025. Studies evaluating mobile health, telemedicine, electronic health records, DHIS2, and artificial intelligence in rural PHC settings were included. Two independent reviewers screened 967 records, and methodological quality was assessed using the Joanna Briggs Institute critical appraisal checklists. Data from 35 studies were synthesized using a structured narrative synthesis. Thirty-five studies from 18 SSA countries were included. Mobile health and DHIS2 were the most frequently implemented technologies. Digital health interventions improved healthcare access, treatment adherence, maternal and child health services, and health information management. Three implementation patterns emerged: differential adoption according to health system readiness, a persistent gap between successful pilot implementation and sustainable scale-up, and the interdependence of infrastructure, workforce, governance, and financing challenges. Benefits were greatest where enabling health system conditions were already in place. Digital health technologies can strengthen rural PHC in SSA but are not a standalone solution. Their effectiveness and sustainability depend on health system readiness, including adequate infrastructure, workforce capacity, governance, and sustainable financing. However, evidence on long-term sustainability, cost-effectiveness, equity impacts and pathways to scale remains limited. Addressing these evidence gaps will support equitable and sustainable digital health implementation.